| NPI | 1851737795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WV 2222) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WV 2222) |
| 101YP2500X Counselor, Professional (Licence: KY 1310) | |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2024-09-16 |